Alone
by SpiderFangWolverine123
Summary: At first, it had just been a bet among the attendings. Why had Alex left?... As Meredith burst into the trauma room, with her emotionally stunted, jackass friend lying unresponsive on the table, she guessed that what really happened was worse than anything they had been able to dream up. One-shot.


**Hey, everybody! I've had this story rattling around for a while now, and I thought it was time I put it out there.**

 **This story contains violence and angst. Read at your own discretion.**

* * *

 **~Alone~**

* * *

 _How had he found her?_

The lights danced above his head, huge circles of glaring brightness staring down at him from overhead. He could hear muffled voices shouting around him, could feel the floor gliding by under wheeled legs, could see the doctors rushing about in their yellow trauma gowns.

" _...29 year old male….contusions in the upper left….gunshot wound…."_

None of it registered, because he couldn't think of anything else, could wonder about nothing else except how he had found her. How she'd been there, lying before him, when she was supposed to be somewhere else. Anywhere else.

 _How had he found her?_

There was a jolt as the doctors transferred him to the examining table in one of the trauma rooms. The door was shut, and some of the chaos was barred outside. The ceiling fluttered in and out of focus, and he turned his head toward the window, watching other gurneys slide by, all loaded with the same weight, a black bag zipped up carefully, hiding the gore and carnage inside. He started counting as they slid by….1….2….3….4….

 _I killed you._ He said to himself, watching one of the black bags go by. _And you. And you._

"Let's start him on antibiotics and a round of fentanyl. Someone page Christina!" Through the flurry of activity above him, he could pull out a familiar face. Dr. Hunt was pressing bandages to his side, watching the monitors in concern.

He tried to speak, but the only thing that came out was a choked groan that took him a moment to realize was his. Hunt looked up, saw his eyes open and clouded with worry and pain, and took a moment to reassure him.

"Alex, you're fine. We got you now, you hear me? You're going to be fine."

 _What about them?_ Alex turned back to the window to see gurneys still rolling by, loaded with the dead weight. _They won't be fine._

He heard a loud, persistent beeping, and his chest cramped with a sudden ache and pressure. It became difficult to draw in a breath. The doctors sprang into motion, and while they seemed to be moving around more, it felt like everything was moving in slow motion. Darkness seeped into the edges of his vision, and his chest felt like it was about to explode.

" _...twenty CCs of epi….crash cart….the hell is Christina?!..."_

He wanted to hold on, he really did. He didn't want to go, even if she was there. But it didn't seem like he had much of a choice. The nice thing was, at least, that nothing hurt anymore. All the pain was gone. He guessed dying was the price he had to pay to be pain free for the first time in almost three weeks. And it was payback, too, in a way, for everyone that he had killed. He'd done that to them. Now it was happening to him. Fair is fair.

" _...charge to two hundred….clear….C'mon, Alex…."_

He felt the jolts as the doctors above him attempted to shock his heart into playing nice, but he knew that it wouldn't work. There was just a point at which surviving wasn't worth the struggle. The body knew that it's occupant didn't even want to be alive, so what was the point into delaying the inevitable?

Darkness clouded his eyes and muffled his ears, and his body was wonderfully numb for the first time in a long time. He let go, finally stopped fighting, and allowed himself to drift off, away into a deep void of nothing.

* * *

Meredith sprinted through the halls of Seattle Grace Mercy West, pager gripped tightly in her hand. She hadn't believed it when she'd gotten the page, so stunned by the message that it took her a minute to shake herself out of the stupor and run to the Pit. Because he was back.

Alex was back. Just not in one piece, as it seemed.

" _Evil Spawn is just chickening out of his boards,"_ Christina had said. _"Wouldn't be the first time he ran away when things got tough."_

" _Without telling anyone?"_ Meredith had countered, not quite so sure.

At first, it had just been a bet among the attendings. Why did Alex leave? Christina bet that he was finally cracking under the pressure, but she said that about anyone and everyone that showed up late or took a sick day, so it didn't really count. Jackson thought he was visiting his family and didn't want anyone to know. April thought he was just being a jackass by ruining her schedule and not showing up to work. But Meredith wasn't so sure.

A lot of things had happened at Seattle Grace Mercy _Death_ , as Christina fondly called it on occasion. There was the shooting, Izzie's cancer, George's death, Callie's accident… Everyone had been affected by the hospital, damaged in some way. And while all the horrible things seemed to be tearing them all apart in some ways, it only made them stronger in others. They'd learned to rely on one another.

Meredith, especially, had learned a lot about her fellow residents. April cleaned when she got nervous. Jackson shut down when he was angry. And Alex... Alex lashed out when he felt himself getting close to someone. Alex didn't like depending on people, didn't like to let people in. So, in some ways, she could understand why people thought Alex might just take off without telling anyone, figuring that nobody would care either way.

And yet, Meredith just knew that wasn't the case. There were people here that he cared about. People that, as hard as he tried not to, he eventually let in and depended on. Arizona Robbins, for one. Her unwavering faith in him and his abilities as a surgeon had eventually worn him down, and Meredith knew that there was no way that Alex would jeopardize his place on her peds cases or her trust for just a couple of days off.

And she would like to consider herself someone that he depended on. They definitely weren't besties, but she'd been there for him when things were rough, and sometimes, though very seldom, she would see a crack in the facade that he put up around other people. When they were talking, some of the arrogance and general douche-bagginess would melt away and reveal the decent human being underneath.

So why had he left? Especially without letting anyone know? Rumors spread rampant around the hospital, mostly generated by the interns, and some bets were even placed about the odds of each reason. Each guess had been more ridiculous and far out than the last. Alex had gone after Izzie. Alex had quit and joined the army. Alex had been recruited by a hospital for a risky surgery involving some young prince or elite youth.

However, Meredith was pretty sure that whatever had really gone down had been worse than anything the interns had been able to think up. As she burst into the trauma room, saw her friend, her damaged, emotionally stunted, jackass friend lying motionless on the trauma table as Dr. Hunt shouted instructions and repeatedly slammed the charged paddles against his chest, Meredith knew that whatever he had been through had been worse than everything faced at Seattle Grace Mercy West before.

The line measuring his heart rate blared a stark, resounding flat line, and Meredith found herself holding her breath in terror as Hunt shouted again. Another jolt, another jump, but no change. Meredith felt her hands go numb as she watched.

"C'mon, Alex, not today." Dr. Hunt growled. "Charge to three hundred." He snapped at the doctor working beside him. The doctor complied quickly, and Hunt shouted "Clear!". He pressed the paddles against Alex's bare chest, and finally, the line began to jump again, registering a faint, but definite heartbeat.

Relief flooded Meredith's body, and she found herself sagging against the doorframe. Dr. Hunt wasted no time in celebration, and quickly shot orders to the other doctors in the room.

"Get him down to an OR now. Page Altman again, and keep paging her until she answers. I don't care if there aren't any ORs available, bump somebody out and _get us in there._ As of now, Alex Karev is a priority one patient, and I'll be damned if I'm going to let him die in my hospital!"

The doctors and interns in the room began the transfer, and Meredith caught up with the bed as was rolling out of the room. Dr. Hunt shook his head when he noticed her.

"You know you can't be here, Meredith." Hunt said regretfully. "I can't let you scrub in."

"We aren't family." Meredith shot back. "I have to be in there. And you don't have any actual reason to keep me out."

Dr. Hunt sighed tersely but didn't protest again. Meredith looked down at Alex's body, his torn shirt, bloody limbs, and an indescribable mix of pity and anger rose within her. She tried to tamp down on the emotions, knew that the last thing Alex would want was to be pitied, but she couldn't help it. One of Alex's hands lay limp across his stomach, and Meredith fought the urge to grab it, if only to let him know that she was there for him.

Looking at his hands, an odd sight registered just as they were reaching the elevators. They hurried inside, pressing the correct button and urging the doors shut quickly. Horror rose within her as she reached over and lifted his hand, turning it to get better light.

"Owen," Meredith choked out, hardly able to speak. Hunt looked over, glancing down at Alex's hand, brow furrowing as he looked for what she saw. Cold rage spread like ice over his features when he noticed what she had only moments ago.

Bruises and raw sores encircled Alex's wrist in a tight band, like a bracelet of pain. Meredith laid his hand down, and reached beside him for his other hand. The same markings scarred his other wrist. One of the interns, eyes wide, lifted the blanket covering Alex's legs to reveal his ankles, bearing the same bruises as his wrists.

Meredith met Hunt's eyes, and she saw her none of her horror reflected there, only a terrible anger that promised vengeance. "Owen…" Meredith started quietly, stopped when she heard a cough from below.

She looked down, to see Alex's eyes fluttering above the oxygen mask pressed against his face. The hand that she held suddenly gripped hers tightly, desperately, and another harsh cough burst from his lungs. His voice rasped, too low to make out, and Meredith shook her head, unable to decipher what he was trying to say.

Hunt reached down and gently pulled the mask from Alex's face, allowing him the room to speak.

"Alex, you're going to be okay," Meredith said, holding his hand as tightly as he was holding hers. "Just try to relax, okay? Everything is fine, I promise."

His head jerked in disagreement, and his mouth moved, trying to form words. His eyes were opened wide, and the fear and desperation in them was heartbreaking to see. All his bravado was gone, his cleverly worked facade broken down to raw terror and vulnerability.

"...wasn't supposed to...find her...safe...have to be...couldn't save her...please…" Alex's voice came out stronger when he tried again, but his words were still insensible.

"Who, Alex?" Meredith asked, unsure that she even wanted to know. "Who couldn't you save?"

"H-how did...he f-find…?" Alex's voice trailed off, shaking uncertainly.

"He's going into shock." Hunt noted in concern.

"Alex, just breathe," Meredith told him as the elevator finally made it and the doors opened, sending them sprinted down the hallway to their OR.

" _How did he find her?_ " Alex whispered, his voice cracking. His eyes were glazed over, staring at a distant something that no one else could see. " _How did he find her?_ "

They made it to the OR doors, and Alex was pushed inside, still whispering brokenly to himself. Meredith watched him go, and then turned to the scrub room, to wash up before surgery. She found Dr. Hunt standing in her way.

"Owen, move, I need to scrub up," Meredith said as she pushed past him.

Hunt didn't try to stop her, but he followed her as she entered the scrub room. "I meant what I said earlier." He said firmly. "You can't be in there."

"We aren't family!" Meredith snapped. "Which means that I can damn well be in there."

"No, Meredith." Dr. Hunt said. "We've got it from here. I'm sorry, but you're too emotionally involved to be a part of this surgery."

"Emotionally-" Meredith repeated incredulously. "He's my friend, Owen. I have to be in there!"

"You and I both know that that is exactly why you can't." Dr. Hunt said. "I'll send someone up later to let you know how it's going."

He stepped up to the sink next to her, tying the surgical mask up without another glance at her. Meredith watched him for a moment more, waiting for him to change his mind, and shoved away from the sink, letting the door slam behind her once she realized that he wasn't going to.

Meredith found some of the residents outside the trauma room that Alex had been brought to. April was staring in horror at the blood that was splashed on the floor. Christina stared impatiently about, arms crossed angrily. Lexie was off for the night, and Jackson was nowhere to be seen. For a split second, Meredith found herself subconsciously looking for Alex, and then ice spread through her gut.

"Meredith, there you are," Christina sighed in exasperation, crossing over to her. April stayed where she was, staring at the mess left behind in the trauma room. "We've been trying to get some answers for the past ten minutes, where the hell have you been?"

"I was with Alex." Meredith said tightly, slightly out of breath.

April turned when she heard that, and Meredith saw moisture in her eyes. "Is he-?"

"He's okay," Meredith said automatically. "I mean, he will be. He's going into surgery now, with Hunt, but they wouldn't let me stay and scrub in." She pulled in a deep breath, bracing herself on her knees.

"Whoa, Mer, are you okay?" Christina asked, reaching a steadying hand out to her.

A wave of nausea washed over her, and Meredith sank into one of the chairs by the wall. "God, I can't even imagine what happened to him."

"What do you mean?" April said, sitting down next to her. "He was….stabbed, right? And I- I heard that there was a gunshot wound, but that's- that's all, right? Right?"

Meredith looked over at April, and shook her head solemnly. "I'm pretty sure that that's not all that happened." In a quiet voice, she relayed what she'd found in the elevator, and new tears sprang into April's eyes. Christina took a step back, looking at the ground with a stunned expression on her face.

"Oh my god, we thought he was at home...or with some girl...we thought that he was just blowing it all off…" April whispered in a horrified voice. "When he was really…" She couldn't finish the thought and covered her mouth with her hand.

Jackson appeared around the corner, his face wan and somber. April turned on him angrily as he approached.

"Where were you, Jackson?" She said. "Alex is….He was…." Tears broke free and trailed down her face as she stuttered.

"I was talking to the cops." Jackson said quietly. "The ones that found him."

All of them fell silent, waiting for Jackson to continue. He shifted on his feet, swallowed, looking at all of them with a stark concern and unease.

"They found him in the basement of Geoffrey O'Reilly. Apparently one of the neighbors called the cops to complain about a rotting smell coming from the guys house. The cops went there, with a search warrant, and they found Karev in the basement."

"R-rotting smell?" April whimpered.

"Karev wasn't the only one there." Jackson continued. He looked down. "He was just the only one found alive."

"What?" Christina stared with wide eyes.

"There were eighteen girls, between the ages of fifteen and twenty one, that they found on his property. All of them had been...cut open. Surgically. Chest cracked and everything. And their hearts…" Jackson paused, shaking his head in disgust. "Their hearts had all been crushed, like someone had spent hours squeezing them. An extreme version of the way heart tissue is after failed open heart compressions."

Meredith went cold, and all she could do was stare at the ground in shock. What did it mean? Had Alex…? Had he wanted…? What the hell had happened?

"Mer, you talked to Alex, right?" Christina said, almost desperately. "Did he say anything?"

Meredith shook her head. "He just kept asking about 'her' _._ Specifically, how 'he' found her."

A choked noise came from Jackson, and Meredith looked over to see him pressing a fist against his mouth. "Jackson? What's wrong?"

Jackson shook his head and turned away. He took a moment to compose himself, and turned back. "They found the bodies of seventeen girls in the cellar that connected to the basement where Karev was."

"But you said there were eighteen," Christina noted, narrowing her eyes.

"Yeah." Jackson confirmed somberly. "There were."

"So where the hell was the eighteenth?" Meredith snapped, tired of all the charades.

Jackson turned, narrowing his eyes at her. "They found the eighteenth body in the same basement as Karev, sitting in his lap."

Jackson waited until the outbursts subsided, and then continued. His voice rang out dully, hopelessly, but it was easy for all of the doctors to hear.

"The eighteenth body they found was the body of sixteen year old Amber Karev."

* * *

Alex was in the ICU, less than twelve hours after intense an intense surgery spanning almost seven hours in which Hunt and Bailey fixed the internal injuries, and Altman tried to keep his heart from going into cardiac arrest.

He was in the ICU, with six broken ribs, a gunshot wound to the abdomen, three deep lacerations in his left pectoral muscle, and a concussion, the severity of which could only be determined once he woke up.

He was in the ICU, and they were just all waiting until he woke up. Meredith found herself distracted, unable to focus on surgery or healthcare. She moved slowly, reread patient charts three times to comprehend the information, and found herself asking people to repeat themselves. She sent interns constantly to the ICU for a status update on him.

It wasn't just her that was concerned. She knew that. But it was like she was the only one willing to show her fear.

April was the only one as vocal as she. But everyone else? They averted their eyes, looked away, pretended that it wasn't happening. They didn't joke around, they weren't that crass, but they didn't talk about him, what was happening, what must have happened to him. They just didn't seem to want to confront the idea that the rude, potty-mouthed, unpleasant Dr. Karev with the biggest _give-em'-hell_ attitude of them all was human. Was vulnerable. And had gone through something more horrific than could be imagined.

They seemed content to avoid the problem. But Meredith couldn't. So when she heard that Alex was starting to wake, she was the first person to know, not counting the nurse who discovered it or the intern who relayed the info to her.

She sprinted up to the ICU, taking the stairs two at a time rather than waste time waiting for the elevator. When she got there, he was only stirring, his eyes not even open yet. The nurse was hovering over him, watching his stats carefully. She seemed relieved to see Meredith there as support, and Meredith quickly crossed to his side.

"Alex?" Meredith called quietly, so as not to embarrass him when he woke. "It's me: Meredith. I'm right here, Alex."

A broken whimper pushed through his lips, and his brow furrowed. Meredith reached for Alex's hand, eyeing the white bandages wrapped around his wrists. As soon as their skin touched, his eyes opened, and she saw the fear and bewilderment running rampant through his head.

"Alex, it's okay. You're safe, now, I-"

"Where is she?" Alex said, his voice slightly hoarse. "Meredith, where is she?"

Meredith's heart dropped. "Alex… Just rest, okay?"

"No, I have to get her…" Alex muttered, his face pinched in concentration. "You don't understand, I can't… can't leave her."

Meredith put a hand on his chest as he tried to sit up. She spoke in a low voice, trying to talk him back into the bed, but he fought his way up, despite the obvious pain it caused him. Meredith shot a look at the nurse, mouthing a desire for help, and the nurse nodded, fleeing from the room.

"Alex, just relax. You're safe here, but you need to rest. You had major surgery and-"

"I can't leave her, Mer," Alex said, and Meredith was shocked to see tears in his eyes. "She can't be alone. I have to…"

"Alex, she…" Meredith started, at a loss at whether Alex was even aware that his sister was dead.

He looked up at her, still fighting to get out of the bed, and the panic and despair in his eyes told her everything she needed to know. He was aware. He was painfully, agonizingly aware that his little sister was dead.

"Don't you understand? _I can't leave her!_ " He shouted, his voice breaking. "She needs me, she needs me, she needs me…" He shoved his leg out of the bed next to Meredith, and tried to stand, getting tangled in the sheets and instead nearly tumbling to the floor.

"Whoa, whoa, Alex!" Meredith shouted, trying to support him and push him back into bed. She heard footsteps behind her, and glanced over to see Owen and Derek rushing into the room. They each grabbed one of Alex's arms and helped her get him back into the bed.

"No, you can't! Let me go!" Alex shouted, shoving back against them aggressively. "She can't be alone! I have to be with her! LET ME GO!"

They got him braced against the bed, with him still thrashing and shouting angrily. Meredith grabbed the needle with Haldol out of the hands of a stunned nurse and rushed to his side. She looked for the IV port, but found that it had been pulled from his arm in the struggle. She would have to inject it directly into his arm.

"You need to hold him still," She said in a tense voice to Owen and Derek.

"We're doing the best we can," Derek responded through a clenched jaw. "Alex, you need to calm down. You're safe now, we promise."

"No, no, god, please, let me go…" Alex said, his anger slowly dissolving to despair. His thrashing subsided, until instead of shoving against Owen and Derek's arms, he was clinging to them, sobs wracking his chest.

"I killed her. I killed her. _I killed her!_ " Alex wept, becoming hysterical.

"Meredith," Derek said, his voice taut.

Meredith leaned over, sliding the needle into Alex's shoulder and pushing the plunger down slowly. For a moment, the drug did nothing, and Alex's distress continued for another endless second. And then his voice quieted, his resistance weakening to feeble twitches. Meredith set aside the syringe, wrapping her hand around Alex's. His fingers gripped hers tightly, despite the drug slowly putting him to sleep. His eyes stared into hers with a feverish desperation.

" _I'm a killer_ ," He said softly, with a certainty that chilled Meredith to the bone. " _I'm the reason she's dead. I killed her. I killed…"_

His voice drifted off as the drug finally enveloped him, and his hand went slack around hers. Meredith waited another moment, as his eyes closed and his breathing evened out. And then she allowed herself to double over above the bed, her braced hands the only thing keeping her upright.

"Meredith…" Derek murmured, placing a gentle hand on her shoulder.

"We need to, um… We need to check…" Meredith stuttered, trying to shove away the horror and sadness so that she could do her damn job. She was a surgeon. She saw cases every single day. Sad cases, hopeless cases. And this was anything but hopeless. She steeled herself, standing upright.

"We need to check his sutures, make sure that he didn't tear anything open that we'll have to fix again." Meredith ordered. Derek reached over, but she shook off his touch. Any amount of pity or sympathy was going to push her over the edge, and she couldn't afford to fall now. Alex needed her.

"Meredith's right," Owen agreed, already leaning over Alex to check things out. "I got this, though. Why don't you two take a break?"

Meredith turned around, one hand pressed against her forehead, to see everyone in the ICU staring at Alex's room. The nurses station was frozen, doctors were paused in the hallway, even patients and visitors stared with wide eyes at Alex.

"Shows over, people!" Meredith shouted angrily. "Move on!"

She turned back to Derek, still glaring hatefully at the people outside, who now busied themselves, consciously not looking in their direction.

"Let's get some curtains in here or something. The last thing he needs is idiots gawking at him every second of the day."

Derek nodded. "I'll take care of it. Why don't you take a walk?"

Meredith nodded, walking out of the room without a backward glance, no idea where she was going other than far, far away.

* * *

Meredith was in the middle of helping Dr. Bailey resect a bowel when the intern popped his head into the room, looking lost and a little unsure.

"What is it, Liam? We're a little busy here." Meredith said, sparing only a partial glance toward him.

"Um, Dr. Grey, Dr. Sheppard wanted me to come find you." Liam said.

"And it seems that you have found me, Liam. Is there a follow up, or was that your only goal?"

Liam shifted his feet nervously. "The patient… I mean, Mr… Dr. Karev is awake."

Meredith looked up, her sure hands stilling. "He's awake?"

"Yes," Liam said, relieved to be able to affirmatively answer her question.

"Is he asking for me?"

"Well, it doesn't seem like he's asking for anything, at the moment." Liam said. "Dr. Sheppard just thought it might be a good idea, if you stopped by."

Meredith looked over at Bailey, who simply nodded and turned her head back to the patient on the table. "Go on ahead, I'll have Liam come on in and assist me if I need it."

Meredith gratefully backed away from the table, shedding her gloves and pulling off the surgery smock. She moved quickly through the halls, her heart in her throat as she thought about her friend awake, finally, after everything that had happened in the past couple days.

She slowed when she reached the ICU, respecting the wish for quiet. She walked quickly for Alex's room, able to spot it from far away by the green curtains covering one of the glass doors. As she neared, Derek stepped out of the room, nodding in greeting when he saw her approach.

"So he's awake?" Meredith asked in a whisper.

Derek nodded. "I did a quick neural check and everything seems fine. He has a concussion, but it's only mild, nothing that we need to be too concerned about."

"Has he said anything?"

Derek shook his head despondently. "He woke up, but other than a brief period of confusion, he hasn't responded to anything I asked him. I'm not a psychiatrist, but it might be some form of trauma or shock." Derek looked intently at Meredith. "I think it might be a good idea to have Dr. Hurst come up and talk to him."

"No. Absolutely not." Meredith said firmly. Her blood still boiled at the mention of the psychiatrist, who tried to have Alex restrained after his outburst. There was even talk of moving him up to psych once he was out of the ICU. Meredith disagreed vehemently, but it was only through Owen's interference that the restraints were removed.

"Meredith-" Derek started.

"He's going to be fine." Meredith said. "The last thing he needs is a shrink prying into his head. It'll make him feel violated and will only shut him down more. He's going to be fine. He just needs time."

Derek nodded wearily, too worn down to fight the issue any longer. "Page me if you need anything." He said, holding her hand for a brief moment before continuing down the hallway.

Meredith walked into the room, steeling herself for the worst. But it was nothing like she expected. To be honest, she wasn't sure what she had expected. They'd said nothing had happened. That he hadn't said anything or asked for anyone, so it wasn't like she'd been expecting that he would be shouting or talking or…. Something. She wasn't sure exactly what her expectations had held. But it certainly hadn't been this.

Alex stared straight up at the ceiling above him. The blanket had been pulled up to his chest, and his hands laid at his sides, relaxed and unmoving. His legs were still, flat, and if Meredith hadn't known better, she would have guessed that he was asleep. Only his open eyes contradicted the theory, and their vacant stare wasn't all that encouraging.

"Alex…" Meredith started, unsure of what she was going to say beyond that. He didn't stir in the slightest, only blinked once.

"Alex, it's me." She said with a little uncertainty. "I know that this must all be…. I mean, it's okay that you're…. God, Alex, please say something. Put me out of my misery."

There was no response. Meredith moved closer. She stood by the side of his bed, watching his face carefully.

"I have no idea what you went through, Alex." Meredith admitted quietly. "I don't know what to say to help you. But I'm here, whenever you're ready." She reached down, placing her cold hand on top of his. He gave no response, nothing to indicate he even realized that she was in the room.

Nothing to indicate he was even alive.

* * *

"I did a full neuro check, Meredith. It isn't neurological."

"How thorough could it have been if he won't even talk? There could be something wrong with him."

"There's nothing wrong, Meredith." Derek said gently, placing a hand on her shoulder. "He just isn't ready to talk."

"Not ready my ass." Meredith shot. "This is Alex we're talking about. He doesn't let stuff break him. He doesn't show pain."

"Maybe this is him trying not to show it." Derek offered. "Just give him time, Meredith. A psychological review couldn't hurt."

"If he won't talk, it won't help him, either." Meredith countered dryly. Derek closed his eyes, a worn smile on his face, and conceded her point, letting the argument lie.

"Well, I have a consult to get to, but if you need me…"

"I'll call." Meredith finished with a small smile. Derek squeezed her hand and walked off down the hallway. Meredith looked over to the room where Alex was staying, where he'd been just as unresponsive for the past five hours.

"C'mon, Alex." Meredith muttered under her breath. "Come back to us."

Terse voices coming down the hallway broke her thoughts, and she turned to see two officers walking down the hallway, Owen Hunt trailing them, speaking angrily.

"It will be entirely detrimental to his recovery to have him reminded of the incident now." Owen was saying as they approached. "He hasn't spoken to anyone and trying to force him to will only delay the healing process."

"Sir, we have seventeen families looking for answers." One of the officers, a no-nonsense looking black man stated. "They want to know why this occurred and until O'Reilly wakes up from the coma, he's the only suspect we have. We need to take his statement."

Owen stopped, forcing the men to pause. "Is that really all you're looking for?" He asked in a quiet voice.

"Yes." The man's partner continued. "We know this is difficult, but the sooner we get this over with, the sooner it's done and he can move on."

"He isn't ready." Owen said firmly. "But we will contact you as soon as he is."

The officer's appraised him for a moment, as if testing his conviction. Finally, the first officer nodded and handed Owen a card, telling him to call the number as soon as "the witness" was ready to speak with them.

Meredith hurried over to Owen as the officers walked away. "O'Reilly? Isn't he the man…?"

"Yes," Owen confirmed, looking around quickly. "He suffered a head wound during the arrest. He's currently in a coma."

Meredith's eyes widened. "He's not here, is he?" She asked tensely.

"No, of course not," Owen said. "He's at Seattle Pres under heavy guard."

"What do we do?" Meredith said. "Alex won't say anything, to anyone. Everyone has tried."

Owen was silent for a moment. "Maybe not everyone."

* * *

Alex was certain this was what death felt like.

Not the painful part. Not the part where everything hurts and you can't breathe because you're screaming so loudly and drowning in your own blood and all you can feel is horror and fear and pain….

The part that came after. The moment when the terror, the anguish, the sadness, the _life…._ It all drained out of them. The quiet that stilled their eyes once their hearts stopped beating. At first it had horrified him, terrified him, the way they just slumped down, as if giving up. But then he'd started to see the peace in their eyes after it was all done. There was no more pain. No more fear. No more anything.

The moment of stillness. It really only lasted a moment, because after a few seconds the stillness just turned to glassiness and he knew he was staring down at nothing more than a cadaver. A shell of a once living thing.

He felt like he was stuck in that moment, suspended in never-ending stillness. It was almost nice. Almost peaceful. He might have enjoyed it if he'd been able to feel anything. Other than dull, muted grief and guilt.

The regular sounds of everyday life had faded away. He couldn't hear the beeping of the machines around him. He couldn't hear the footsteps of the people outside. He couldn't smell that antiseptic smell that most patients complained off. He couldn't even see the ceiling as a whole. Just a sea of white, tiles dancing around until it formed a writhing mass of lines and dots.

He wanted to stay there forever. On the edge of consciousness, able to feel guilt and sadness over what he'd done but unable to be consumed by it. Able to feel his pain as agonizingly as possible without feeling the urge to end it all and join the rest of them in the eternal stillness.

Because he didn't deserve something so easy.

Even after the first one, he knew that he was going to fight to stay alive. Part of him told himself that he was fighting to save people, fighting to survive so that he could get away somehow and stop it all. But the other part of him knew better. It knew that he was only staying alive so that he could feel the full extent of his regret. The horror and disbelief that shook him to the core, rattling the very foundation of who he was.

He had to live, because to die was to be free of pain and he didn't deserve it. Didn't deserve to be peaceful until he had driven himself mad with all of the darkness inside himself. All the lives he couldn't save, all the lives he took himself. It was like a tidal wave towering over him, threatening to crush him into the ground. He wanted to stay in this place where he could stick his head into the water, feel the agony of it in his lungs, feel the panic in his body as it wracked for relief but couldn't find it. And yet he wouldn't die. He'd live to feel every endless moment of it.

Alex heard someone enter his room. They stood by the door, seemingly unsure about what to do or what to say. Alex wished that they would know that there was nothing that they could say. No phrases of comfort or gentle concoction of words that would ease the tsunami inside him. Because he had to atone for what he'd done. Because he could still hear their screams and knew that they would want him to suffer.

Because he didn't deserve it.

"Alex?"

The voice was gentle, sweet, high-pitched. It was a voice accustomed to speaking with children, using small words that they could understand, and always talking in assumption of the best case scenario to ease their fear. It was a voice that could be sharp and demanding when necessary, and patient and calm when the situation needed it. It was a voice that had somehow reached him years ago, when he was young and stupid and just looked out for himself.

"Alex, it's Arizona."

He didn't move to acknowledge her. He didn't even blink his eyes. He had turned to stone, and one false move would shatter him into pieces.

"I know you don't want to talk. I wouldn't want to, either."

Her words dug into him, carving him up from the inside out. She knew. She knew every horrific thing that he had done and she hated him for it. Her words turned the muted pain inside of him into a blazing fire, burning what was left of his broken soul.

"I just wanted you to know that whatever you did to survive was justified, Alex. No one can blame you for surviving."

Fissures spread along his skin, threatening to crack him into small, jagged shards.

"But it's not enough to survive, Alex. You have to start living. I know you might not be ready for that, yet, and that's okay. You can take as long as you need. Just know that when you're ready, we'll all be here for you."

It hurt to breathe, it hurt to think, it hurt to _exist._ He didn't move, fearful of making the pain worse. The nauseating guilt, the heartbreaking grief, and bone-crushing regret. He had to close his eyes to process all of it, and allowed the pain to wash over him in waves, stealing his breath and rattling his heart.

What was left of it.

* * *

Jackson was rounding the corner in the ER when he ran into April. She was carrying a pile of charts, and he futilely lunged to try and catch them before they hit the ground with little success.

He handed the one he'd managed to save back to her with a sheepish grin. "Sorry about that."

April wasn't even looking at him. She snatched the chart out of his hands and dropped down next to him as he collected the others. "It's fine, don't worry about it." April said absentmindedly with a thoughtful frown on her face.

"Hey, wait, hold up," Jackson said, grabbing her arm as she started to hurry off. "What's on your mind?" He could tell it wasn't only concern over Karev that had her so out of sorts.

April shook her head. "It's the name. O'Reilly. I can't shake this feeling like I've heard it before or something."

"The guy that had Karev? Why would you think you knew his name?"

"I don't know." April admitted exasperatedly. "But it's been bothering me all day. I haven't been able to focus on patient charts or actual _patients_ or anything!" April threw her hands up into the air, almost dropping the charts they'd just picked up.

"Whoa, hold on," Jackson steadied her. "Let me help you with this, okay? And then I'll help you with the name."

April gratefully handed him some of the charts and then looked up at him in confusion. "Why are you helping me? Not that I'm not thankful, but there are probably other things that you could be doing that would be more helpful than-"

Jackson laughed and cut her off. "Let's just say that the hospital needs you clearheaded."

After leaving the charts with the nurses in the nurses' station, the two headed for the nearest computer.

"You think he was a patient here?" Jackson suggested.

"That was the first thing I thought of." April said. "I already checked the patient records going back to last spring. There were a couple O'Reillys, but none of them were this guy. And none were related, as far as I could see."

Jackson clicked through a few files. "He wasn't ever an employee here, was he?"

April shook her head. "Checked that, too."

As Jackson clicked back to the home page to sift through some more records, he had a sinking feeling that this was going to take longer than he'd hoped.

An hour and a half later, both of them were frazzled.

"Maybe the parent of a patient?"

"No, we checked all the O'Reillys on the list. None of them were related to him. What if he was a volunteer or something?"

"His name isn't on the list. What if he was a priest or something, coming to visit patients? The hospital doesn't record their visits."

"Really, you see this guy as a priest? And besides, even if he _was_ , the fact that there aren't any records of their visits means that it wouldn't help us any."

"Right. What if he was a visitor to somebody that hung around the hospital and that's how you heard his name?"

April sighed in exasperation. "We aren't any closer. It was probably just a name close to his that I heard somewhere. I'm sorry, Jackson. I've just wasted your time."

Jackson shook his head. "No, it's fine, April. Really, all I was missing was a legal meeting with HR about some lady who wasn't satisfied with her butt lift." He offered a tired laugh. "I would do anything to postpone that crap for as long as possible."

"Wait a second," April gripped his arm. "Legal!"

"What?"

"Oh my gosh, I completely forgot! Three weeks ago I was helping with the paperwork in HR, and I remember filing this case that was completely insane about a dad suing the hospital because his daughter's doctor supposedly let her die."

Jackson blinked and held up a hand, his head spinning with the overload of information. "You help with paperwork in HR?"

April paused, shooting him a defensive look. "Only when I'm stressed. It relaxes me."

"Okay," Jackson accepted, moving onto more important issues. "But what does this have to do with O'Reilly?"

"Because _he_ was the one suing the hospital." April said, sounding extremely relieve to have solved the puzzle. She pulled up an online form of the paperwork, and Jackson scanned it quickly. Sure enough, it had Geoffrey O'Reilly's name on it, along with his accusations of malpractice.

"Okay, but you said he was suing for the maltreatment of his daughter. We didn't find any O'Reillys in our system. None that were related to him."

"His daughter has a different last name than him. He's technically not her real father, because her mother had her with this other man who she got a divorce with, like, two months into their marriage. A year later she was married to Geoffrey."

"What was the daughter's name?" Jackson asked, leaning over the keyboard.

"Hailey Griffith." April supplied easily. It seemed that once she got her memory jogged, April remembered every last detail about this case.

Jackson typed her name into the search bar for the patient records, and a single file popped up. Jackson opened it, read the information that included patient history, and his mood grew somber.

"She came in for a heart transplant." He read. "But she went into heart failure on the table, and they couldn't bring her back. She was only fourteen."

April leaned over his shoulder. "Her mother has a file in here, too. She came in after a car accident, with a severe head wound. They stabilized her, but… she was brain dead. The two of them had to decide to pull the plug. Not even a year and a half later Hailey died."

"God, that's awful." Jackson murmured. "No wonder this guy flew off the handle."

Suddenly, April's nails dug into his shoulder. She leaned closer to the screen, pointing a finger to it's surface. "Jackson, Hailey's doctor…."

Jackson looked to where her finger was pointing, and he felt a lead weight sink in his gut. He might have guessed, if he had thought about it for another half-second. But he didn't have to guess. And he knew, without a doubt, that Geoffrey picking Alex Karev as his victim hadn't been random. It had been entirely intentional.

Because Alex had been her doctor.

* * *

 _He was trying not to panic. Trying, and ultimately failing, if he was being truthful with himself._

 _The basement had been dark for hours, and even the light that had shone through the small clouded window at the top of the wall he'd been facing for hours hadn't been visible for a long time. He couldn't hear anything, except for the occasional drone of a car passing by or the creak of an old house._

 _He was lying on his side on the filthy floor, staring at a drain set in the concrete a few feet from his face. His hands were trussed together with thick rope and bound behind his back, and his ankles had been tied together as well. A few strips of tape covered a sock shoved in his mouth, making it hard to breathe, let alone yell for help._

 _It was impossible to know how long he'd been here. He couldn't even remember how he'd gotten here. He remembered seeing Geoffrey standing by his car, walking over, prepared to launch into the usual speech about how they'd done everything they could have and there wasn't anything more that any of them could have done. He'd opened his mouth to speak, and then-_

 _Nothing. There was nothing but pain and darkness after that._

 _And then he'd woken up here. Bound. Gagged. Probably breathing his last breaths._

 _The thought made his lungs seize, and Alex forced himself to relax. Panic would not help him get out. Panic would get him killed._

 _Another car approached, and Alex wondered if he could somehow throw something up, hit the ceiling or wall… Anything to signal to somebody that he was down here. That he was trapped._

 _The rumble of the approaching car drew nearer, and then got quieter. But not like it was passing… more like it was stopping. For a single moment, Alex allowed himself to hope that it was someone coming to help him. And then he realized that no one would even realize he was missing. He wasn't supposed to be back in to work until Monday morning. And he wasn't exactly the type to have friends over. So no one would have called help for him._

 _Which meant, if it wasn't help, then it had to be…_

 _The basement door banged open. Alex was facing away from the staircase, but he heard the heavy footsteps walking down toward him. All the panic he'd tried to suppress came rushing back, in a wave of dizziness and choking that nearly caused him to scream._

 _He kicked his legs out, hoping futilely that the rope might break, or slip free, or… or… jesus, he didn't know. He just didn't want to die. Dear god, he didn't want to die._

 _Rough hands grabbed the collar of his shirt and hauled him up. Alex's eyes widened as Geoffrey lifted him off the ground as easily as if he'd weighed nothing at all. Geoffrey was a big man, but Alex had never thought him capable of something like that. He'd never thought him capable of any of this._

 _Slowly, Geoffrey reached up and pulled the gag from Alex's teeth. Alex felt his mouth open, more out of reflex than anything, and Geoffrey reached up, grabbing Alex's jaw with an iron grip. "You can scream if you want." Geoffrey growled. "No one will hear you."_

 _Alex closed his mouth and tugged his chin away from Geoffrey's hand. He watched the man warily, waiting for his next move._

" _You didn't save her." Geoffrey deadpanned, staring with loathing into Alex's eyes. The scariest thing was the lack of passion in Geoffrey's gaze. There was no rage. No fury. Only steely, cold, stone hard conviction. "I don't care what excuses you give. The only thing that matters is that she died."_

 _The look in Geoffrey's eye was unlike anything he'd faced before, a kind of hatred that was permanent and undying. The kind that promised vengeance._

" _You didn't get it right with my Hailey. She died because of your incompetence." The grip tightened on Alex's shirt, and he choked against the sudden restriction. Geoffrey leaned forward until his face was inches from Alex's._

" _Now you're going to try again. Until you succeed."_

 _Geoffrey opened his hands, letting Alex fall to the hard concrete. Alex felt the air rush out of his lungs from the impact, but still gathered enough air to call out to Geoffrey's receding form._

" _What do you mean?" He called, to no response. "What do you mean?!"_

Alex jerked up in bed, heart racing wildly. Sweat soaked his body and the sheets below him, permeating the air with the scent of fear. As his heart slowed, he felt the aches and stabs all over his body from his various injuries.

He looked up at the monitor beside him, watching the small lines measuring his heart rate slowly even out. It was cruel, he thought, that the machine could make it appear that his heart was normal, healthy, when it felt like it was breaking into pieces.

How could he have done it all? It had all felt like a nightmare; something straight out of a horror film. Sometimes he'd looked down at his hands, covered in blood, the instruments stained red with death still clenched in his fingers, and part of him had decided that there was no way it was him doing it. It was easier, after he'd decided that. Easier to reach in their chests and sift through the organs and squeeze it tightly, even as he knew they were dead and gone. Even as Geoffrey screamed at him from behind, gun barrel pressed firmly against his skull.

There had been distance, sometimes, down there in the basement. He'd never really forgotten that he was himself, that he was where he was, but the death, the pain, it didn't hurt sometimes when he distanced himself. It didn't seem real, so it didn't seem so horrifying.

But there was no distance here. There was no separating himself from the things that he had done. Not where there were people that knew him, knew what he had done. Not when the bodies were cooling in freezers only a few floors below him, his every failure written on the wounds in their flesh.

 _It had been days since he'd eaten. He'd resorted to sucking water off his fingers, which he'd dipped into a small puddle created by dripping water from the ceiling. His ribs ached from the beating Geoffrey had given him the other day, but Alex knew better than to complain. He'd had worse._

 _Suddenly, the door burst open, and Alex flinched in surprise. He hadn't heard the truck approaching. A girl's cries filled the silent basement, and fear slid like ice into his gut._

 _Geoffrey appeared, dragging her by her hair. He pulled her down the stairs, shoving her to her knees only feet from Alex. Alex stared helplessly at the girl, but she didn't lift her eyes, staying put with her head down and arms wrapped around her stomach. Her sobs echoed._

" _What are you doing?" Alex pleaded with Geoffrey. "Please, kill me, do whatever you want. Your problem is with me. Just me."_

 _Geoffrey grabbed the girl's hair, yanking her head back. She gasped and shrieked, staring at Alex with tears streaming down her cheeks. She wore a blue coat, green scarf wrapped around her neck. Her eyes were green. Her hair was red. A small smattering of freckles ran across her nose._

" _It's going to be okay," Alex said desperately, reaching a hand out to her._

" _Please," The girl gasped. "I don't-"_

 _Geoffrey reached to his belt with his free hand, and lifted it high. Alex only saw a flash, a reflection of the sparse light in the room, before the knife came down and embedded itself in girl's chest. Alex heard his screams and shouts echoing around the room, but it sounded far away and distant._

 _The girl choked, eyes wide, staring at the floor in front of her. Geoffrey yanked the knife back out, and she collapsed onto her side. Blood burbled out of her chest, and the girl coughed, sending a spray of blood into the air._

" _Don't worry." Geoffrey said, his voice void of emotion. "The good doctor is going to save you." He turned to Alex with a deadpan stare. "Aren't you?"_

He couldn't escape it. He couldn't escape the pain. Everything he'd done. Every time he failed, every time Geoffrey went out for another. Every life he destroyed with his failure. If he'd only saved that one little girl. If he'd been a little more observant, if he'd had a heart ready for her, if he hadn't been so damn blaise about the whole thing. He could look back and see the trail of mistakes that lead him there, but he couldn't go back and fix any of them. He could only lay there and feel the pain he caused. Feel the death he caused.

" _You failed again." Geoffrey stared down at him, gun shaking in his hands. "YOU FAILED AGAIN!"_

 _Alex couldn't respond, looking down at the body before him, bloodied beyond recognition. The tools he'd used to crack her chest lay abandoned on the concrete next to him, soiled and stained. He could still feel her organs in his hands. He could feel her blood slipping through his fingers._

 _Alex turned and vomited on the concrete, retching until there was nothing left. He stared at the body next to the mess, too horrified to cry out but too horrified to stay still. His whole body felt numb and cold at the same time, and he could feel the fog hovering on the distance, ready to take over._

" _I can't do it." He heard himself saying. "I can't do it anymore. I won't do it."_

 _Seventeen lives. Seventeen lives he hadn't saved. He'd watched them die. Watched Geoffrey murder all of them. Felt himself murder them, too, when he hadn't been able to bring them back. And then what he was forced to do with their bodies, mutilating them, destroying them in that way…._

" _I won't do it anymore. You can't make me. You'll have to kill me. Just kill me." His voice was barely more than a whisper, but it carried in the silent space._

" _I don't think I'll have to kill you." Geoffrey hissed, crouching down close. "I just have to find better incentive."_

"No no no no no no…." Alex felt the panic coming on, and a sudden pull urged him from the bed. He stood, yanking the wires and tubes from his body with small jerks, and then quickly walking out of the room. He knew someone would be there soon, and he had to get away before they did.

He had to find her. He couldn't let her be alone.

" _Alex? Where are we? Why are we here? Alex, what's going on?"_

The windows were dark, hallways lit dimly. Shadows arched across the floor, reaching out to scrape and scratch at his feet. He found the staircase, shoving the heavy door open and wincing as the effort strained his ribs.

" _Your brother has made some very grave mistakes. Mistakes that he is trying to fix now. I really hope that he doesn't fail with you."_

The stairs were steeper than he remembered them being before. He was hardly halfway down, and already gasping from the effort. He was sure he would never make it back up. But up didn't matter. Down was the goal.

" _What? Alex, what's happening? What are you doing?! Stop! No, please! ALEX!"_

He tripped, his foot slipping past one of the stairs. Alex clung to the railing, but he still slid down the remaining few steps to the basement. Alex gritted his teeth against the coursing pain, and slowly hauled himself up to his feet. He was almost there. He just had to find her.

" _No, please, stop. Don't do this. Don't hurt her. I'll do anything, just don't. No… NO, STOP!"_

The floor was icy against his feet as he stumbled toward the doors of the morgue. Even through the stupid hospital socks. No one was in the morgue this late at night, and the lights were off, doors locked. But Alex still remembered the code from his intern days, sneaking down here with other interns on dares. Occasionally getting in some extra practice on each other. Stupid, silly stuff.

There was nothing silly about it now.

 _Blood. So much blood. It bubbled underneath his fingers as he pressed against her chest, trying to stop the bleeding. It dribbled from her lips as she stared up at him with wide, fearful eyes. Her hands clenched around his wrists tightly, though her grip was slowly failing._

" _You're going to be okay," Alex promised, tears making it difficult to see, terror making it hard to breathe. "Just hold on, Amber. I'm going to make it okay."_

The morgue was ten degrees cooler than the rest of the hospital, and Alex swore he could see his own breath as he moved through the room. The steel tables caught his eye, as did the instruments lined up in glass cabinets. But eventually, his eyes moved to the metal doors at the back of the room.

 _Amber coughed, a choking, wet sound, and hauled in a laboring breath. Her mouth opened, trying to force out words. Alex shook his head, whispering for her to save her strength, but Amber persisted._

" _J-just don't l-leave me, okay?" Her words were hoarse and slurred, but Alex heard them clearly._

He reached out for one of them, knowing somehow, deep inside, that it was her. He pulled the handle, and it hissed as it swung open. He pulled the tray with a numb hand. It slid out, and Alex dropped to his knees, one hand still clinging to the cold tray. It slid along the rim as he went down, and his fingers hit something else, just as icy as the cool metal. It took him a minute to realize that it was her hand.

 _He lifted one hand from her chest to hold her lax hand tightly. "I won't, Amber. I promise. I'm right here, okay? Just focus on me. Don't worry about anything else. I'm here."_

His fingers curled around her stiff wrist. Deep sobs wracked his chest, but no tears came. His grief was too deep to be washed away.

" _I love you, Alex," Amber's voice was barely a whisper, her eyes going glassy and empty._

 _Alex leaned down, pressing his forehead against hers. "I won't leave you, Amber. Not now or ever. I love you, now and forever."_

"Now and forever."

Alex heard voices calling down the staircase, footsteps pounding down the steps. He knew they were coming, but couldn't bring himself to push the tray back or stand up. Let them see him broken. What did he care?

"Alex!" Meredith came running over, relief ringing in her voice. She faltered when she neared, her eyes falling on the scene before her. She reached out slowly, placing a hand on Alex's shoulder.

"Alex… I…"

"I promised I wouldn't leave her." Alex said hoarsely. "I just didn't want her to be alone."

Meredith crouched down. "I know, Alex. And she won't be alone. She'll be here, with you." Meredith reached out and placed a hand against Alex's chest, right over his heart. "As long as you love her, she'll never be alone."

Meredith wrapped an arm around him, and after a moment of stoicism, he collapsed into her arms, crying into his friend's shoulder. He let the pain wash over him, the sadness, the terror, the guilt. All the bad, mixing around in a black pit inside of him. But there was also the good. The gratitude at being alive. The support of his friends. The hope that maybe it would get better.

"You're going to be okay." Meredith murmured into his ear, rocking slightly back and forth.

"You won't be alone."

* * *

 **As always, leave a review and let me know what you think. Constructive criticism is always welcome- as well as gushing complements! ;)**


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